Academic excellence for business and the professions

Reading and dyslexia in deaf children

Dr Rosalind Herman

City University London

Childhood deafness• 44,0004 children in the UK have a permanent

hearing loss• A quarter have a severe-profound level of loss

that significantly impacts access to spoken language

• Of these, approximately two thirds use spoken language

4CRIDE 2012

Recent developments

• Reading develops more slowly • Reading delay increases with age5,6

• Are all deaf readers dyslexic? • No, good deaf readers do exist7,8

• BUT some may be dyslexic

Reading and deaf children

5Conrad 1979, 6Wauters et al. 2006, 7Marschark et al. 2007, 8Gravenstede & Roy 2009

Reading in deaf and hearing children

• Hearing children with reading difficulties are likely to be diagnosed as dyslexic

• Deaf children’s difficulties are attributed solely to their sensory loss

• Given the genetic basis of dyslexia2, might some deaf children also be dyslexic?

1Allen, 1986; Conrad, 1979; Kyle & Harris, 2010; 2011; Wauters, van Bon & Tellings, 2006; 2Pennington & Olson, 2005

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• Evidence reading develops in same way as hearing children

• For both, phonological skills are important – Hearing children rely on listening– Deaf children additionally use lip-reading

(speechreading)9

Why start with oral deaf children?

9Kyle & Harris 2010; 2011

Identification of dyslexia in deaf readers: the challenges

•No tests for deaf children•Can we use tests developed for hearing

children?

Phase 1: Oral deaf children

Aims:1. Investigate the suitability of literacy and

dyslexia-sensitive tests for deaf children 2. Collect data from a representative sample of

oral deaf children3. Compare deaf readers to hearing children

with and without dyslexia 4. Find out if some deaf children have dyslexia

Phase 2: Signing deaf children

Participants in Phase 1• 79 severely-profoundly children deaf from birth

• Year 6 (10-11years), primary education in English

• 61% cochlear implants, 39% digital hearing aids: no difference in reading and phonological skills so combined into one group

• Reference group of 20 hearing dyslexic children

Measures

Literacy

Phonological skills

Vocabulary

Non-verbalSpeech readingSpeech intelligibility

Namingspeed

Test battery

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Literacy– Single words, nonword reading, reading comprehension, spelling

Phonological tasks– Digit span– Fluency: rhyme, alliteration– Phoneme deletion (rein/deer)– Spoonerism (fun with “b”; riding boot)– Naming speed

Non verbal IQ Expressive vocabulary Speechreading and speech intelligibility Familiar sequences

Parent and teacher questionnaires

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• Family history of speech/language, hearing, reading problems

• Child’s hearing background, type of amplification (hearing aid/cochlear implant), any additional difficulties

• Parental education, ethnicity• School and home communication method• Methods used for teaching reading

Could the children do the tests?

Deaf-friendly test administration: listening conditions

• Quiet and distraction free test environment, important for hearing aid/cochlear implant users

• Amplification fully functional prior to assessment

14

• Optimal seating and lighting• Access to clear speech patterns to support

speechreading

15

Deaf-friendly test administration: visual access

• Signing/gesture/writing used as needed to explain tasks

• Additional practice items offered where needed

• Sensitivity to deaf children’s speech patterns in scoring

Note: all tests administered using spoken language only in Phase 1

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Tester skills

Are deaf children with cochlear implants better readers?

• 61% with implants • 39% with hearing aids• No differences between groups

Differences among children with cochlear implants

• Small group of children implanted ≤18mths: no below average scores

• Children implanted ≥2yrs: mixed picture, good and poor readers

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Comparing deaf participants with hearing test norms

• Deaf children had below average scores (<-1SD) on most of the literacy and phonological tasks

• Deaf children particularly poor on vocabulary• Deaf children showed a normal spread of scores on naming speed for digits, NVIQ, speech reading, semantic fluency

Comparing deaf and hearing dyslexic children:

Single word reading

52%

48%

Deaf children

Average readers

Poor readers70%

30%

Hearing dyslexic children

Average readers

Poor readers

70%

30%

Hearing dyslexic children

Average readersPoor readers

52%42%

6%

Deaf children

Average readers

Poor readers

Extremely poor readers

Comparing deaf and hearing dyslexic children:

Single word reading

Other literacy scores for deaf group

Reading comprehension: • 39% deaf in normal range

Spelling:• 60% deaf in normal range

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•Vocabulary•Phoneme deletion

Word reading

•Phoneme deletion•Spoonerisms

Nonword reading

•Vocabulary•Naming speed for digitsSpelling

Evaluating our measures: Predictors of literacy skills

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Can we identify dyslexia in oral deaf children?

Dyslexic readers

(PR)

Average readers

Poor readers,

poor language (PR + PL)

Average readers,

poor language

(PL)

Poor Gooddecoding decodingskills skills

(Nonword reading)

Poor language skills(Expressive vocabulary)

Good language skills

Deaf 30%

Deaf 22%Deaf 48%

Deaf 0%

Classification of reading skills

Deaf children’s range of scores on single word reading and vocabulary

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Deaf children compared with hearing dyslexic children

Can we separate poor reading from language difficulties in deaf children?

Can we separate poor reading from language difficulties in deaf children?

What about deaf children’s phonological skills?

Comparing deaf children and hearing dyslexic children with below average scores

Literacy, language and

phonological scores

Hearing dyslexic children: % Below average literacy scores

Deaf and hearing dyslexic children: % Below average literacy scores

Deaf and hearing dyslexic children: % Below average language and

comprehension scores

Reading comprehension Vocabulary0

20

40

60

Deaf Hearing dyslexic

Deaf and hearing dyslexic children: Below average phonological skills

Spelling errors: Use of phonological route?

Types of spelling errors:phonetic error ‘lepered’ non-phonetic ‘cuircle’

Spelling errors: Use of phonological route?

Better literacy Poorer literacy

Limited early language experience

Poor speech perception and production

Poor phonological representations and awareness

Inefficient word learningPoor reading

Why do deaf children have reading problems? The role of early language experience

Poor vocabulary development

So were any deaf readers dyslexic?

Average readers

Poor readers

6% ‘extremely poor’ deaf readers:• severe phonological deficits• lowest scores across all measuresWe cannot tell if they have dyslexiaTheir response to intervention may be informative

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We looked at all poor deaf readers’ performance on measures that identified poor reading in the hearing dyslexic group

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Eight deaf children with average speech intelligibility and nonverbal scores BUT low scores on naming speedThree with average non-word reading unlikely to be dyslexic

Naming speed a key measure in identifying dyslexia

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Of the five remaining, all had:– Very poor spelling (phonetic spelling errors)– Very poor phonological skills (spoonerisms, phoneme

deletion)– Very poor sequencing skills (months in correct sequence)– 4/5 were boys

These children fit the typical dyslexic profile

Some oral deaf children do have a dyslexic profile BUT these are not the only poor readers

Half* our oral deaf sample are poor readers, all with poor language and weak phonological skills

The phonological deficits are the same as those found in hearing children with dyslexia

*Using more recent norms for BAS single word reading test, 71% are poor readers

Phase 1: Conclusions

These children are poorly equipped for secondary school All poor deaf readers need support not just the few with

dyslexia Interventions that work with hearing dyslexic children

should be available to poor deaf readersLike hearing children with severe reading difficulties, deaf

children need intensive, individualised, ongoing interventions to address their language and phonological deficits

Ideally, intervention should be early to prevent these problems

What happens next?

Breaking the cycle

Through learning to read and spell, children can develop their phonological awareness skills and extend their vocabularies

Phase 2: Deaf signing children Questions we hope to answer

What does a good reader in this group look like using our tests?

If signing helps language development, is reading better among children with good signing skills?

Are phonological skills important to reading in signers?What is the profile of good and poor readers? Is there a dyslexic profile among signers?What might help reading development in signers who

struggle with reading?46

“the Government wants every child to succeed…the ability to read well is key to success in education and an essential life skill… (the need for) high quality provision

for securing literacy for all children”

The Rose Report, 2009

What about deaf children?

AcknowledgementsThanks to…

My collaborators, Penny Roy & Fiona KyleThe Nuffield Foundation All the children, families and schools who took partOur research assistants: Zoe Shergold for phase 1 and

Catherine Barnett for phase 2 Advisory group: Sue Brownson, Margaret Harris, Mairead MacSweeney, Barbara Maughan, Ian Noon, Kate Rowley, Karen Simpson, Maggie Snowling, Ruth Swanwick & Tyron Woolfe

r.c.herman@city.ac.uk 48